What is endometriosis?
Endometriosis is a chronic gynecological disease in which tissue similar to the endometrium (which normally lines the inside of the uterus) grows outside of it, affecting organs such as the ovaries, Fallopian tubes, peritoneum, intestine, or even the bladder.
This tissue responds to the hormonal changes of the menstrual cycle, causing inflammation, internal bleeding, the formation of adhesions, and pain.
Types of Endometriosis
Superficial endometriosis
Where is it located?
On the surface of the peritoneum (inner lining of the abdomen and pelvis).
Common symptoms
Mild to moderate pelvic pain, menstrual discomfort.
Diagnosis
It can be difficult to detect via imaging, but techniques such as gynecological ultrasound or magnetic resonance imaging (MRI) can help. However, the technique that provides a result closest to reality is laparoscopy.
Ovarian endometriosis (endometriomas)
Where is it located?
Inside the ovaries, forming cysts filled with blood content (“chocolate cysts”).
Common symptoms
Ovarian pain, menstrual alterations, infertility.
Diagnosis
Transvaginal ultrasound is very effective for detecting them.
Deep infiltrating endometriosis
Where is it located?
It infiltrates more than 5 mm into organs such as the rectum, bladder, uterosacral ligaments, and rectovaginal septum.
Common symptoms
Severe pain during menstruation, defecation, urination, or sexual intercourse.
Diagnosis
Requires MRI and/or expert laparoscopy.
Surgical treatment
Requires nerve preservation and precise dissection of pelvic spaces, ideally with robotic surgery or advanced laparoscopy.
Symptoms of endometriosis
Symptoms vary depending on the location and extent of the disease:
Severe menstrual pain (dysmenorrhea).
Chronic pelvic pain.
Pain during sexual intercourse (dyspareunia).
Pain when defecating or when urinating.
Infertility.
Fatigue, abdominal bloating, digestive disorders.
Treatments
When the patient wishes to maintain her reproductive capacity, the surgical approach must be conservative, precise, and respectful of the gynecological anatomy. The goal is to remove the endometriosis lesions without compromising the uterus, ovaries, or the nerve structures involved in pelvic function.
It is a minimally invasive technique that allows for the removal of endometriosis foci through small abdominal incisions, using a camera and specialized surgical tools.
Advantages:
- It preserves the uterus and ovaries.
- Less postoperative pain.
- Faster recovery.
- Good anatomical visualisation.
Limitations:
In cases of deep endometriosis, the dissection can be technically very complex.
The most advanced option for preserving fertility in deep endometriosis. It is a robot-assisted surgical technique that allows for an enlarged three-dimensional view and millimeter-scale precision in tissue dissection.
Notable advantages:
- Greater precision in the removal of infiltrating lesions.
- Better nerve preservation, which is essential for avoiding urinary, intestinal, and sexual complications.
- Superior visualization of deep pelvic spaces.
- Ideal for patients with deep endometriosis who wish to maintain their fertility.
Why is it key in these cases?
Deep endometriosis can affect nerve structures and vital organs. Poorly performed surgery can compromise reproductive, urinary, or intestinal function. Robotic surgery allows for seeing more, in greater detail, and performing precise and safe dissection, reducing risks and improving outcomes.
Treatments in cases of no desire to become pregnant
Radical surgery may include hysterectomy (removal of the uterus) and, in some cases, oophorectomy (removal of the ovaries), especially if symptoms are very severe or the endometriosis is widespread.
This decision does not imply a loss, but rather a conscious choice oriented toward physical and emotional well-being. Many women who have lived for years with chronic pain, heavy bleeding, or limitations in their daily lives find this surgery to be a definitive solution and an opportunity to reclaim their lives.
Hysterectomy is not a minor decision, and it must be made with clear information, emotional support, and respect for each woman’s values. In many cases, it is performed via laparoscopy or robotic surgery, which allows for a faster recovery, less pain, and better functional results.
- Minimally invasive technique.
- Good visualization and fast recovery.
- Requires high surgical expertise, especially in deep endometriosis.
- Greater precision in tissue dissection.
- Expanded and three-dimensional visualization.
- Safer nerve preservation, especially in complex areas such as the pararectal, vesicouterine, and retrocervical spaces.
- Ideal for cases of deep infiltrating endometriosis, where the anatomy is distorted and meticulous surgery is required.
